Why Do I Have Pelvic Pain With No Diagnosis?

Pelvic pain with no diagnosis often isn’t coming from an organ at all. It’s held in the muscles and fascia of the pelvic floor – tissue that ultrasounds, bloodwork, and most exams aren’t designed to measure. That’s why your results come back clean while the pain stays real. And tissue that’s been gripping can learn to let go.

As a Certified Somatic Sex Educator and Sexological Bodyworker specializing in genital de-armoring, I hear the same story again and again: years of appointments, normal results, and a quiet fear that it must be in your head. It isn’t. This article is from material I explore in my podcast interview with Martin Beaudoin, a former linguistics and speech pathology professor who became a bodyworker focused on women’s health, and whose training I attended in Mexico in 2021.

One thing first. A clean workup is worth having. Painful intercourse and pelvic pain have many possible medical causes worth ruling out, and any new, sudden or worsening pain belongs with your doctor before anything else. This article is for what’s left when those tests have been done and nothing was found.

What causes pelvic pain with no diagnosis?

Very often, the pelvic floor itself. It’s a bowl of muscle and connective tissue that holds your organs, wraps the openings of your body, and responds to everything you live through. It tightens when you’re startled, when you brace against pain, when you hold your bladder through a long workday, and when some part of you has learned that this area isn’t safe.

Usually it lets go afterward. Sometimes it doesn’t. Tension that’s held long enough becomes the tissue’s new normal, and a muscle that can’t release can ache, burn, throb, and make touch or penetration hard to bear.

When Martin left academia to work full time as a bodyworker, he didn’t plan to work with the pelvis at all. What changed his direction was what he kept finding. “As I was working with women, I realized that almost every woman I worked with had gynecological issues or sexual issues that were completely unaddressed by the medical system,” he told me. “I trusted that gynecology and urology were treating women well. But that’s not the case.”

Why do my scans and bloodwork come back normal?

Because they’re looking for a different kind of problem. Imaging is built to find structures: a cyst, a mass, an inflamed organ. Bloodwork looks for infection, hormone levels and markers of disease. Neither one measures how tightly a muscle is holding, or whether a band of fascia has been gripping for ten years.

So the report says normal, and in its own terms it’s accurate. Nothing structural is found. What it can’t tell you is what a trained hand can feel in a few minutes: tissue that’s short, dense, tender, and braced.

Can pelvic floor tension cause pain somewhere else?

Yes. A pelvic floor holding tension doesn’t always hurt where it’s held. Tight pelvic floor muscles can send pain into the low back, the hips, the tailbone, the bladder, the inner thighs, or deep into the belly. That’s one reason people end up moving from specialist to specialist. Each one examines the place that hurts, while the source sits somewhere nobody is looking.

Pain and numbness are often two faces of the same guarding. Some bodies brace and hurt. Others brace and go quiet. I’ve written about the second pattern in why you can’t feel anything during sex, and the mechanism underneath is the same.

Why does sex hurt when nothing is medically wrong?

When the pelvic floor is holding tension, penetration meets tissue that’s already at the end of its range. It can register as burning, tearing, or a wall the body won’t let anything past. That isn’t your body refusing intimacy. It’s your body protecting you with the only tool it has.

That guarding is often as much nervous system as muscle. A body that has learned this area isn’t safe will tighten before a thought has formed, the same protective pattern I explore in healing what the body holds without a memory attached. This is why lubricant and “just relax” so rarely reach it. The muscle isn’t responding to instruction. It responds to safety, time, and skilled, patient touch.

What is Thiele stripping?

Thiele stripping is a fascia release protocol for the pelvic floor. It uses slow, sustained pressure along the muscles that form the pelvic bowl, including the pubococcygeus, iliococcygeus, coccygeus and obturator internus, so that tissue that’s been gripping can soften and lengthen.

Charles Thiele developed the technique in the 1930s, originally for anal work. Decades later, researchers at Stanford adapted it for vaginal and anal work and copyrighted their version. Martin went back to Thiele’s original article, which he says was very hard to find, and built his own adaptation that covers more of the pelvis. As he tells it, when he shared it publicly he was told it was a professional secret. His view is that the original belongs to Thiele, and that people being able to help themselves isn’t a danger.

His reason for covering more ground is that the pelvis works as a system. “The fascia, the ligaments work together,” Martin says. “There are fascial lines within the pelvis that need to balance.” And: “What is lax is as important as what is tense. You need to work with all the tissue to reestablish balance.”

I use Thiele stripping in almost every session where I’m doing internal work. It releases tension in the pelvic bowl that nearly every body I meet is carrying. I believe it belongs in every pelvic floor training program.

Is internal pelvic work safe?

It should be, and you’re entitled to know how a practitioner keeps it that way. Martin’s answer is the one I’d want from anyone: “It’s very important to have a serious discussion with the client on what they want to experience, what they’re open to. The boundaries have to be set by them initially. That’s the most important part.”

He begins with history: physical, social, family and sexual. Sometimes trauma work or simple trust-building has to come before any internal work at all. “We only do what their body and their heart tells them,” he says. “If they’re not comfortable with the procedure, we don’t do it.”

Internal work isn’t sex. It’s specific, therapeutic touch with a clear purpose, roles agreed before anything begins, and your “no” honored at every moment. A practitioner should be able to tell you their training, explain what they’ll do and why, and stop the instant you ask.

A practice: mapping your own pelvic floor

This is a gentle way to begin learning your own terrain, adapted from the posterior-wall mapping Martin teaches. The goal isn’t to fix anything. It’s to find out what’s there. If you don’t have a vaginal canal, the external steps are a good place to start, and a practitioner can guide internal work.

1. Make time and space. Twenty to thirty unhurried minutes, somewhere private. Lie on your back with a pillow under your hips and have a good lubricant nearby.
2. Breathe into the pelvis. One hand on your lower belly. Take ten slow breaths and let each exhale soften the floor of your pelvis rather than push it.
3. Start outside. Press gently around the perineum and along the inner edges of your sitting bones. Notice anything tender, tight, or strangely numb.
4. Enter slowly. When you’re ready, with plenty of lubricant, rest one finger just inside the vaginal opening. Don’t move yet. Let the tissue get used to contact for several breaths.
5. Map the back wall. Curve your fingertip down toward the rectum and press lightly at a few points, like the numbers on a clock face. At each one, notice whether it’s soft, tight, tender, or blank.
6. Wait rather than push. At a tender spot, keep light, steady pressure and breathe. Tissue often softens under patient contact. If the pain turns sharp or you find yourself bracing, ease off or stop.
7. Rest and write it down. Hands back on your belly. Note what you found and how your pelvis feels now.

If this brings up fear, old memories, or more than you can comfortably hold, stop. That’s not failure. It’s information, and a sign this part of the work deserves a trained witness.

Listen to the full conversation: Pleasure as Medicine: Pelvic Healing & Sexual Recovery on the Your Body Remembers Pleasure podcast.

Common questions

1. Is pelvic pain with no diagnosis all in my head?

No. Muscle tension is physical, measurable by hand, and produces genuine pain. The nervous system does participate, because sustained guarding is a nervous system decision expressed in muscle. That makes it a body and brain event, which is very different from imaginary.

2. Can a tight pelvic floor cause pain during sex?

It’s one of the most common causes. When the pelvic floor is held short, penetration meets tissue already at the end of its range, which registers as burning, tearing or a wall. Releasing the muscle usually changes the experience more than lubricant or relaxation advice does.

3. Is internal pelvic work the same as sex?

No. The purpose, the structure and the roles are different. The touch is aimed at specific tissue for a specific therapeutic outcome, boundaries are set by the client before anything begins, and the practitioner isn’t a participant in a sexual exchange. As Martin puts it, nothing happens that the client’s body and heart don’t agree to.

4. Does Thiele stripping hurt?

It can be intense on tissue that’s been gripping for years, but it shouldn’t be an ordeal, and pain that makes you brace is counterproductive. The pressure is slow and sustained rather than sharp. A good practitioner works at an intensity you can breathe through and stops when you say stop.

5. Can I work on this myself, or do I need a practitioner?

A lot can be done alone: breath, external release, gentle self-exploration, learning your own map. Deeper fascia protocols like Thiele stripping are hard to reach on yourself at the right angle and pressure, so for those a trained practitioner is worth it. Many people do both.

Your pelvis has been asking

If you’ve spent years being told nothing is wrong, I’d offer this: your pain was never imaginary, and a clean report was never the end of the story. Tissue that learned to grip can learn something else, gently, at the pace your body sets.

If you want a place to begin, the Genital Awakening Meditation is free, and comes with a 12-point genital armor checklist so you can see what your own body may be holding.

And when you’re ready to go deeper, The 3 Keys to Genital De-armoring is where I teach this work in full: how armoring forms in pelvic tissue, and how it softens.

Rahi Chun is a Certified Somatic Sex Educator and Sexological Bodyworker specializing in genital de-armoring, and host of the podcast Your Body Remembers Pleasure. With gratitude to Martin Beaudoin, bodyworker and teacher.